Prevalence of anemia in pregnant women JBKMC January-June 2016, Vol. 1, No.

Original Article

PREVALENCE OF ANAEMIA IN PREGNANT WOMEN OF

DISTRICT MARDAN
Shahana Nisar1, Shafi Ullah1, Muhammad Said2, Muhammad Khalid3
1
Department of Community Medicine, Bacha Khan Medical College, Mardan, Pakistan
2
Department of ENT and Head & Neck Surgery, Bacha Khan Medical College, Mardan, Pakistan
3
Department of Community Medicine, Gajju Khan Medical College, Swabi, Pakistan
ABSTRACT
Objective: The primary objective of our study was to know about the prevalence of anaemia in pregnant women
attending Gynecology OPD and to compare it in different trimesters. To find the frequency of mild, moderate and severe
types of anaemia in pregnant women. To compare anemia in educated and uneducated working ladies and housewives.
Materials & Methods: The study being conducted was a cross sectional study. The study area was Gynae OPD
Mardan Medical Complex. It took two months to conduct the study. A written consent was taken from the participants
after whom questionnaires were filled by the researchers according to participant data. Data from the questionnaires
was entered & analyzed via SPSS version 16 & then presented in tabular, bar and pie chart form. On the basis of
this data detailed discussion was done & conclusions were drawn.
Results: The results presented in our study have revealed that out of 150 patients 74.8% were anaemic and 25.2%
were non-anaemic. In the 1ST Trimester (out of 50) Anaemic: 54%, Non anaemic: 46%.In the 2ND Trimester
(out of 50) Anaemic: 82%, Non anaemic: 18%. In the 3rd Trimester (out of 50) Anaemic: 88%, Non anaemic:
12%. When classified into mild, moderate and severely anaemic (Out of 150), mildly anaemic subjects were found to
be 56.4%, moderately anaemic subjects 38.3%, and severely anaemic were 5.4%.In the educated subjects 73.9% were
anaemic and 26.1% were non-anaemic while among the uneducated subjects 75.9% were anaemic and 24.7% were
non-anaemic. Out of 14 working ladies 57.1% were anaemic and 42.2% were non anaemic. Out of 136 House
wives 76.5%were anaemic and 23.5% were non-anaemic.
Conclusion: From this study it is concluded that anaemia, as in other parts of the world, is also prevalent in
Mardan Pakistan. Anaemia is mostly prevalent in the pregnant women in the last trimester of pregnancy. In both
educated and uneducated women the prevalence of anemia is the same and anemia is more common in the House wives
as compared to the working ladies.
Key Words: Anaemia, pregnant females, Iron-deficiency, prevalence.

INTRODUCTION below 13 g/dl in men over 15years, below 12 g/dl in non-preg-

A
nant women over 15years, and below 11 g/dl in pregnant
naemia is one of the major health disorders af-
women”
fecting significant proportion of population not
only in developing countries but also in developed Nutritional iron deficiency is highest in segments
countries. This threat is more alarming in developing of the population that are experiencing peak growth
countries where poverty, illiteracy, poor nutrition and rates, such as infants, young children, and pregnant
health status may contribute to high risk for develop- women1. The risk of developing iron deficiency is
ment of anaemia. greatest during pregnancy, since maternal iron require-
ments are substantially higher than average absorbable
“The WHO defines anaemia as a haemoglobin concentration
iron intakes2. If a woman’s diet does not contain
Correspondence: enough iron to meet these needs, the body can meet
Dr. Shahana Nisar
Lecturer foetal requirements only by drawing upon maternal
Department of Community Medicine iron stores. The demands of the developing foetus may
Bacha khan Medical College Mardan, KPK, cause the mother to develop iron deficiency anaemia
Cell: 0301-8197202
Email: shahananisar48@yahoo.com
if she had inadequate iron stores at the beginning of

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Prevalence of anemia in pregnant women JBKMC January-June 2016, Vol. 1, No. 1

the pregnancy1. In developing countries where malaria, oping countries, where women have a risk of dying in
hookworm infestations, and helminthic infections are pregnancy and childbirth that is 50-100 times greater
endemic, these may be the primary causes of anaemia, than that of women in the developed world6. In the
rather than iron deficiency, or they may compound the developing world, rates are as high as 700 per 100,000
effects of iron-deficiency anaemia; thus, they must be live births in many parts of Africa and in some coun-
treated along with iron deficiency in order to reduce tries in south Asia. These large differences in risk are
rates of anaemia3. related primarily to differences in available obstetric
care for women living in areas with inadequate ante-
There is substantial observational evidence show-
natal and delivery care facilities5.
ing that maternal iron deficiency anaemia prior to and
in early pregnancy places the mother at increased risk A detailed compilation of anaemia prevalence
of preterm birth or low-birth-weight delivery4. Severe in women published by WHO includes estimates of
anaemia (haemoglobin level<80 g/L) is associated with maternal mortality from anaemia for nine selected
the birth of small babies, as a consequence of both countries. These estimates range from 27 per 100,000
preterm labour and growth restriction. The minimum live births in India to 194 per 100,000 live births in a
incidence of low birth weight and preterm birth is hospital-based study in Pakistan8.
found when haemoglobin concentrations are 95–105
Before the introduction of safe blood transfusion
g/L (118).
and specific anti-anaemic therapy the prognosis for
Centres for Disease Control and Prevention both mother and child was poor. Recently no maternal
(CDC) recommend screening for anaemia in pregnant deaths have been recorded in this country, but even
women and universal iron supplementation to meet the here one cannot afford to be complacent about the
iron requirements of pregnancy except in the presence incidence of puerperal morbidity or the significantly
of certain genetic disorders such as hemochromatosis5. raised miscarriage, prematurity and peri-natal mortality
rates.
Antenatal care is one of the pillars of safe
motherhood interventions that are believed to reduce A research was done on anaemia and associat-
maternal and peri-natal mortality. Universal access to ed risk factors among pregnant women Southwest
antenatal care is a matter of priority in both developed Ethiopia revealed that the high prevalence of anae-
and developing countries the condition may then be mia indicates it is currently a serious health problem
treated or monitored to secure a better outcome5. of pregnant women living in that area. Plasmodium
malaria and soil transmitted helminthic infections
Anaemia is a common nutritional health disorder
were significantly associated with anaemia. Antenatal
worldwide. It varies with age, race, climate, nutrition,
care should promote de-worming and education on
poverty, literacy and health conditions etc. Anaemia
personal hygiene. Therefore, there is a need to design
is also a major problem associated with pregnancy.6
strategies that help to diagnose pregnant women for
According to WHO 53 to 90% of the expecting
malaria and other infections during their antenatal care
mothers are anaemic in the developing countries. Asia
(ANC) visit instead of testing for only haemoglobin
has the highest rates of anaemia in the world due to
(Hb) levels and blood group9. In the long run, edu-
socioeconomic and cultural factors. The estimated
cational and economic empowerment of the women
prevalence of anaemia increases throughout the course
is the key to reducing the overall prevalence of  anae-
of pregnancy and its consequences maybe highly risky
mia to the barest minimum10. It is important to rule
for both the mother and her child. (Pakistan has a total
out other causes, in addition to the deficiencies, which
fertility rate of 4.33%7 and a maternal mortality ratio of
produce anaemia in a patient. It is essential to suggest
297 per 100,000 live births6,making it 1 of 6 countries
the administration of iron supplements not only during
contributing to more than 50% of all maternal deaths
the antenatal period but also after birth o even after a
worldwide.7Maternal mortality continues to be a major
miscarriage to fulfil the need for depleted iron.
health problem. Nearly 600,000 women die each year
as a result of complications of pregnancy and child- In severe anaemia (haemoglobin being lower than
birth; most of these deaths could be prevented with 8.0 g/L), iron doses higher than 120 mg a day may be
attainable resources and skills.8 required. Treatment shall always begin orally, but if not
tolerated parenteral administration maybe required11.
The worldwide maternal mortality ratio (annual
number of deaths of women from pregnancy related The knowledge about anaemia in pregnancy &
causes per 100,000 live births) is estimated to be 390 its complications in the patients is very low (6.48%).
per 100, 00 live births. Most of these occur in devel- And 94.59% of pregnant women in 3rd trimester

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Prevalence of anemia in pregnant women JBKMC January-June 2016, Vol. 1, No. 1

attended the antenatal care 1st time. 48.64% of cases regarding food sources of iron, especially prior to
lie between the age group 18-24 years and shows early becoming pregnant, and taught how food choices can
pregnancy12. Research on Evaluation of treatment of either enhance or interfere with iron absorption15.
iron deficiency anaemia in pregnancy. The conclusion
was that the prevalence of anaemia increased as preg- OBJECTIVES
nancy progressed, therefore It is necessary that the
physician requests the patient 3 or 4 blood studies to 1. The primary objective of my study was to know
keep adequate prenatal care and have the opportunity about the prevalence of anemia in pregnant
for early detection of anemia11. women attending Gynae OPD and to compare
it in different trimesters.
Research was done for the Determination of
anaemia among pregnant women in rural Uganda. 2. To find the frequency of mild, moderate and
The high prevalence of anaemia observed in Kibo- severe types of anemia in pregnant women.
ga district can be attributed to poverty and limited 3. To compare anemia in educated and uneducated
access to nutrition and health education information and to compare anemia in working ladies and
which lead to low uptake and utilization of the pub- housewives.
lic-health intervention package to combat anaemia in
pregnancy12. MATERIALS AND METHODS
A research was done to determine the anaemia It was a Cross-sectional study all pregnant women
prevalence and risk factors in pregnant women in an in the first, second and third trimester (total 50 in 1st
urban area of Pakistan. A high percentage of women Trimester, 50 in 2nd Trimester and 50 in 3rd Trimester)
at 20 to 26 weeks of pregnancy had mild to moderate in the age group (17-49) years, who attended the Gynae
anaemia. Pica, tea consumption, and low intake of eggs OPD of Mardan Medial Complex, were included in
and red meat were associated with anaemia. Women of
the study. The purpose, benefits and risks of the study
childbearing age should be provided nutritional edu-
were properly demonstrated to the voluntary partic-
cation regarding food sources of iron, especially prior
to becoming pregnant, and taught how food choices ipants before obtaining any information and blood
can either enhance or interfere with iron absorption13. sample collection. All information was collected by
interviewing of pregnant women. All the women were
A study was conducted for determination of informed that the information will be kept confiden-
prevalence and aetiology of anaemia during pregnancy tial and obtained data will be used only for research
in southern Benin, in conjunction with revision of purpose.
national management policy. This study demonstrates
a high prevalence of moderate anaemia during preg- Inclusion Criteria: All the women of repro-
nancy and suggests that it is mainly due to intestinal ductive age group (15 to 49 years) who were pregnant,
helminthiasis. These findings underline the impor- and came for antenatal check-up to the Gynae OPD
tance of preventive antihelmintics treatment during of Mardan Medical Complex.
pregnancy14.
Exclusion criteria: All the women of reproduc-
Research was done for the Determination of tive age group (15 to 49 years) who were not pregnant,
anaemia among pregnant women in rural Uganda. and came for check-up to the Gynae OPD of Mardan
The high prevalence of anaemia observed in Kibo- Medical Complex.
ga district can be attributed to poverty and limited
access to nutrition and health education information Data collection Procedure: Data was collected
which lead to low uptake and utilization of the pub- from patients seeking antenatal care at Gynae OPD of
lic-health intervention package to combat anaemia in Mardan Medical Complex. The subjects were evalu-
pregnancy12. ated by data collectors for the physical appearance i.e.
A study was done to determine anaemia preva- conjunctival pallor, palmer pallor, facial pallor, short-
lence and risk factors in pregnant women in an urban ness of breath and nail bed pallor. The patients were
area of Pakistan. A high percentage of women at 20 to referred to MMC laboratory for detecting haemoglobin
26 weeks of pregnancy had mild to moderate anaemia. level. The haemoglobin level also categorized into mild
Pica, tea consumption, and low intake of eggs and red anaemic (10.0-10.9), moderate anaemic (8.1-9.9) and
meat were associated with anaemia. Women of child- severe anaemic (<8). The results were then obtained
bearing age should be provided nutritional education from the lab in a coordinated order to avoid errors.

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Prevalence of anemia in pregnant women JBKMC January-June 2016, Vol. 1, No. 1

Data analysis Procedure: Data was analysed

using suitable statistical tools by SPSS software and on
the basis of this data detailed discussion was done &
conclusion was drawn. Keeping the conclusion in view,
suggestions and recommendations were formulated &
put forward to benefit further research studies.

RESULTS
The present study was to evaluate the preva-
lence/ frequency of anaemia during pregnancy in Mar-
dan. 150 pregnant women during three months period
from April to June 2015 were selected randomly. The
age of the study subjects varied from 14 to 49 years. uneducated subjects 75.9% were anaemic and 24.7%
According to the blood picture, out of those 150, 75% were non-anaemic. Out of 14 working ladies 57.1%
were anaemic and 25% were non-anaemic (Fig. 1). We were anaemic and 42.2% were non anaemic. Out of
founded that Prevalence of anaemia in pregnancy (out 136 House wives 76.5%were anaemic and 23.5% were
of 150 subjects)Anaemic74.8% and Non anaemic were non-anaemic.
25.2%. In the 1st Trimester (out of 50) Anaemic were
54% and Non anaemic were 46%. In the 2nd Trimes- DISCUSSION
ter (out of 50 Anaemic were 82% and Non-anaemic Anaemia during pregnancy continues to be a
were18%. In the 3rd Trimester Anaemic were 88% common clinical problem with high rates of prevalence
and Non anaemic were 12%. Out of 150, 56% were, (35 to 75%) in many developing countries. In India,
Mild, 38% were Moderate and 5%were having Severe prevalence rate of anaemia was 88%, in Tanzania 86%,
anaemia. In the educated subjects 73.9% were anae- Nigeria 47%, Indonesia 74%, Philippines 48% and
mic and 26.1% were non-anaemic while among the Bangladesh 47%6. The present study was undertaken
to study the frequency of anaemia during pregnancy
in district Mardan. A total of 150 patients (50 in each
trimester) were selected through random sampling
method for a cross-Sectional study in duration of 3
months i.e. from 1st September to 31st November. In
the present study on the basis of blood picture of 150
pregnant women, 75% pregnant women were anaemic
and 25% Non Anaemic. Our findings are close to the
figures findings in Lahore, where 80% were anaemic
and 20% were non-anaemic17, similar findings were
observed in the In the study conducted in Faisalabad18.
It was observed in the study that the prevalence
of anaemia increased with progression of pregnancy
with a higher % in the 3rd trimester and with increasing
parity. In the 1st Trimester (out of 50) Anaemic were
54% and Non anaemic were 46%. In the 2nd Trimester
Anaemic were 82% and Non anaemic were18%. In
the 3rd Trimester Anaemic were 88% and Non anae-
mic were 12%. Which is similar to a study done in
Faisalabad where 2.7% of the anaemic pregnant ladies
were in 1st trimester, 8% are in 2nd and 89.3% in 3rd
trimester18.
Out of 150, 56% were, Mild, 38 % were Mod-
erate and 5% were having Severe anaemic which is

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Prevalence of anemia in pregnant women JBKMC January-June 2016, Vol. 1, No. 1

consistent with a study conducted in Faisalabad where 6. World Health Organization. Trends in Maternal Mortali-
the mild anaemic women were 24%, moderate anaemic ty 1990 to 2008: 2010. Available from: http://whqlibdoc.
who.int/publications/2010/9789241500265_eng.pdf.
33% and severely anaemic 18%.
7. National Institute of population Studies (NIPS) Islam-
High frequency of anaemic patients in 3rd abad Pakistan. Status of women reproductive health and
trimester may be due to increased demand of micro family planning survey: Main report. 2007. Available
nutrients during this period in the background of from http://www.nips.org.pk/[Date accessed 1st Feb
poor dietary habits.19 Furthermore, no significant 2015].
relationship was detected between anaemia and level 8. Hogan MC, Foreman KJ, Naghavi M, Ahn SY, Wang M,
of education. In present study the mean age of the et al. Maternal mortality for 181 countries,1980-2008:sys-
pregnant women was 26.07±5.04 years. A study from tematic analysis of progress towards Millennium Devel-
Karachi has reported a mean age of the pregnant opment goal 5. Lancet.2010; 375(9726):1609-23.
women as 28.28±5.20 years20. 9. Vijaynath, Patil RS,  Jitendra, Patel A. Prevalence of
anemia in pregnancy. Indian J Appl Basic Med Sci. 2010;
CONCLUSION 12b (15): 45-50.

It is suggested that nutrition plays an important 10. University of Maiduguri Teaching Hospital. Borno State,
Nigeria. Available From mbbukar07@yahoo.com.
role in causing anaemia during pregnancy. Screening
of anaemic patients, their proper treatment, and avail- 11. Department of Biomedical Sciences. School of Health,
ability of fortified food (wheat flour with folic acid and Adama Science and Technology University, Asella,
Ethiopia.
iron), salt with iron and milk sugar to build long term
iron stores, is the only key to reduce anaemia. 12. Program in International and Community Nutrition.
Room 3252, Myer Hall, One Shields Ave., University
Further studies are needed to have findings of California. Davis, CA 95616, USA.
representing the whole nation. Furthermore, lab
13. Health Promotion Hospital, Regional Health Centre 8,
scale studies are urgently required to find the specific Nakhonsawan, Thailand. bunyarit_su@hotmail.com.
causes of anaemia in pregnant women especially in
14. Department of Obstetrics and Gynecology. Aga Khan
developing countries. The need of the day is to educate
University Medical Centre,Karachi.
people especially pregnant women about their health
by launching special health promotional programs and 15. Program in International and Community Nutrition,
Room 3252, Myer Hall, One Shields Ave., University of
supplementation programs.
California, Davis, CA 95616, USA. nbansari@ucdavis.
edu.
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